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Hand, Foot & Mouth Disease

What is hand, foot, and mouth disease?

Hand, foot, and mouth disease (HFMD) is a common illness of infants and children. It is characterized by fever, sores in the mouth, and a rash with blisters. HFMD begins with a mild fever, poor appetite, general malaise, and frequently a sore throat. One or two days after the fever begins, sores develop in the mouth. They begin as small red spots that blister and then often become ulcers usually located on the tongue, gums, and inside of the cheeks. Skin rashes develop over one to two days with flat or raised red spots, some with blisters. The rash does not itch, and it is usually located on the palms of the hands and soles of the feet, and occasinally on the buttocks.

Is HFMD the same as bovine/swine foot-and-mouth disease?

No. HFMD is a different disease to the foot-and-mouth disease of cattle, sheep, and swine mentioned frequently in the press in the last few months. Although similarly named, the two diseases are not related and caused by different viruses. There are no serious human health implications from bovine/swine foot and mouth disease, although humans in contact with infected animals very occasionally suffer mild respiratory symptoms. Humans cannot become infected by eating meat from infected animals.

What causes HFMD?

Several different viruses cause HFMD, the most common being coxsackievirus A16 and occasionally other strains of enteroviruses. The enterovirus group includes polioviruses, coxsackieviruses, and echoviruses.

Is it contagious?

Yes, HFMD is moderately contagious. Infection is spread from person-to-person by direct contact with nose and throat discharges or the stool of infected people. A person is most contagious during the first week of the illness. HFMD is not transmitted to or from pets and other animals.

How soon will someone become ill after getting infected?

The usual period from infection to onset of symptoms is 3 to 7 days. Fever is often the first symptom of HFMD.

Who is at risk for HFMD?

HFMD occurs mainly in children under 10 years old, but adults may also be at risk. Infection results in immunity to a specific virus, but a subsequent infection may occur due to contact with a different member of the enterovirus group.

When and where does HFMD occur?

Individual cases and outbreaks of HFMD occur worldwide, more frequently in summer and early autumn.

How is HFMD diagnosed?

HFMD is one of many infections that result in mouth sores. Another common cause is oral herpesvirus infection, which produces an inflammation of the mouth and gums (sometimes called stomatitis). Physicians can distinguish between HFMD and other causes of mouth sores based on the age of the patient, the pattern of symptoms reported, and the appearance of rashes and sores present on examination. A throat swab or stool specimen may be sent to a laboratory to determine which enterovirus caused the illness, though this is not commonly done since testing often takes two to four weeks.

How is HFMD treated?

No specific anti-viral treatment is available for enterovirus infections. Overall treatment focuses on managing the fever via appropriate dose of anti-pyretic given every 4 hours and the use of numbing ointments to help children eat.

As for solid food, be prepared for a child who simply won't eat very well for a few days. Palatable foods will need to be bland, soft, not spicy, and not hot in temperature. Warm noodles with a little butter and salt may be tolerated, as well as bread or soft rolls. Items such as toast, spicy and tomato-based foods, potato chips, and crunchy cereal are usually refused by children with this illness.

Many parents can diagnose this illness themselves and a visit to the doctor is usually not required. Antibiotics do nothing to cure or prevent this disease. HMFD is about as contagious as the common cold and roughly as serious.

Can HFMD be prevented?

There is nothing that can be done to prevent you from getting the illness if you have been exposed, but only a fraction of the people who are exposed will develop symptoms. Preventative measures include frequent hand washing, disinfection of contaminated surfaces using cleaners such as a diluted solution of bleach made by mixing 1 capful of household bleach containing chlorine with 1 gallon water), and washing soiled articles of clothing in hot water. Children are often excluded from childcare programs, schools, or other group settings during the first few days of the illness. Leave the small blisters that may form on the feet and hands alone, as they will heal much better if not disturbed.

Is HFMD serious?

Usually not. The infection is classfied as a mild disease and nearly all patients recover without medical treatment in seven to ten days. There are no common complications. Rarely, this illness may be associated with "aseptic" or viral meningitis, in which the person has fever, headache, stiff neck, or back pain, and may need to be hospitalized for a few days. Another viral associated with HFMD, EV71, may also cause viral meningitis and rarely more serious diseases such as encephalitis or a poliomyelitis-like paralysis. Cases of fatal encephalitis occurred during outbreaks of HFMD in Malaysia in 1997, Taiwan in 1998 and Malaysia/Singapore in 2000.

Additional info on Hand Foot and Mouth disease from the US Center for Disease Control

If you have medical-related questions about living in Indonesia to ask of medical professionals, see Ask the Experts.

We trust this information will assist you in making correct choices regarding your health and welfare. However, it is not intended to be a substitute for personalized advice from your medical adviser.

Our appreciation to Dr. Paul Vandewalle of International SOS, An AEA Company who has contributed this article to assist expatriate families in Indonesia.